APPLICATION FOR PUBLIC ACCESS TO RECORDS
TO: Aaron M. Martin, Records Access Officer
Edwin L. Crawford County Office Building, Government Plaza
P.O. Box 1766, Binghamton, NY 13902
Telephone: (607) 778-2287 FAX: (607) 778-8869
Email: FOIL@co.broome.ny.us Website: http://www.gobroomecounty.com/FOIL.php
I HEREBY REQUEST TO INSPECT RECORDS AT BROOME COUNTY’S DEPARTMENT/OFFICE OF_____________________:
I would like to (Please check a box):
Review documents by appointment. (Not available for Sheriff’s records)
Have copies made at 25¢ per (regular-sized) page or at the set fee structure for other formats, and agree to pay for these copies.
(Other Set Fees: $2.00 for CD’s or DVD’s, $2.00 for Polaroid photographs (if available), $.28 for digital full color picture (if available) printed on 8 ½”
x 11” paper, $.50 for pictures printed on photographic paper. There is no charge if a request is under 4 pages or if it can be provided by email.)
I would like an estimate of the number of pages involved in the above request prior to any copies being made.
Please describe the record you are requesting. Be specific – especially with dates and time periods:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Name (Please Print): ________________________________________ Phone: ________________
Mailing Address ___________________________________________________________________
Email (Optional)___________________________________________________________________
Signature_____________________________________________ Date: ______________________
Please circle your preferred method of contact: Phone Mailing Address Email
If we have reproduced records that you have not paid for, this new request will not be processed until the prior request is settled.
FOR AGENCY USE ONLY
____Approved ________Number of Copies Responsive to the Request
Denied for Reason(s) checked below:
____Confidential Disclosure
____Part of Investigatory Files
____Unwarranted Invasion of Personal Privacy
____Record is not Maintained by this Agency
____Record of Which this Agency is Legal Custodian
Cannot be Found
____Record Does not Exist
____Exempted by Statute Other than the FOI Law
____Other (Specify) ________________________
_________________________________________________________________________________________
Signature Title Date
APPEALS PROCESS
NOTICE TO APPLICANT: You have the right to appeal a denial of this request by application to the Records Access Officer.
A decision will be made by the Appeals Officer, the Broome County Attorney’s Office, 6
th
Floor Edwin L. Crawford County
Office Building, in writing with a full explanation within 10 business days from receiving the appeal.
I, ______________________________, hereby appeal my Denied FOIL Request dated: _________
SIGNATURE:_________________________________________ Date: _______________________
ADDRESS: _______________________________________________________________________
